ABSTRACT
Sentinel lymph node biopsy (SLNB) has almost completely replaced complete axillary lymph node dissection (CALND) as the first-line axillary procedure for clinically node-negative early stage breast cancer. We assessed the incidence of axillary relapse in patients with negative SLNB who had no additional CALND (group 1, n = 481) and in patients whose SLNB contained micrometastases and had no further CALND (group 2, n = 45). All patients were operated on between November 1997 and December 2005 and followed at the Jules Bordet Institute. The median follow-up was 48 months. A mean of 2.2 sentinel lymph nodes was removed per patient. Axillary relapse was observed in only one patient (0.2%) in group 1 and in none of the patients in group 2. This study confirms that the axillary recurrence rate after long-term follow-up of patients with a negative sentinel lymph node is very rare, provided that the selection criteria are judicious.
Subject(s)
Breast Neoplasms/pathology , Lymph Node Excision , Neoplasm Recurrence, Local/epidemiology , Sentinel Lymph Node Biopsy , Adult , Aged , Aged, 80 and over , Axilla , Breast Neoplasms/surgery , Female , Humans , Lymphatic Metastasis , Middle AgedABSTRACT
BACKGROUND: The accuracy of a molecular reverse transcriptase-polymerase chain reaction (RT-PCR)-based assay for metastases detection in axillary sentinel lymph nodes (SLNs) has recently been validated in our institution and adopted as an intraoperative test for breast cancer patient management. METHODS: Molecular assay performance was compared to standard postoperative histology in 253 consecutive patients with clinically node-negative T1 early breast cancer (<2 cm). RESULTS: The molecular assay correctly identified 26/27 macrometastases and 11/15 micrometastases. Overall concordance with histopathology was 93%, with 87% sensitivity, 94% specificity, and 75% positive and 97% negative predictive values. The molecular assay was positive in 13/14 patients with SLNs and nonsentinel lymph node (axillary lymph node [ALN])-positive histology. Notably, 2/12 patients with assay-positive/histology-negative SLNs exhibited ALN positivity. CONCLUSIONS: This molecular assay can raise the standard of care for patient management as its accuracy is similar to that of standard postoperative histology with the advantage of being standardized, objective, and fast enough for intraoperative use.
Subject(s)
Breast Neoplasms/pathology , Keratin-19/genetics , Lymphatic Metastasis/diagnosis , Neoplasm Proteins/genetics , Reverse Transcriptase Polymerase Chain Reaction , Uteroglobin/genetics , Axilla , Biomarkers, Tumor/genetics , Breast Neoplasms/genetics , Female , Humans , Lymph Node Excision , Lymph Nodes/pathology , Mammaglobin A , Middle Aged , Predictive Value of Tests , RNA/analysis , Sensitivity and Specificity , Sentinel Lymph Node BiopsyABSTRACT
In breast surgery and anatomy, the composition of the breast itself could vary from patient to patient due to respective proportions of glandular and fatty tissue. There is no easy and reliable way to predict these proportions. The purpose of this study was to evaluate the respective proportions of glands and fat in breasts. By analysing mastectomy specimens we were able to quantify the amounts of glandular and fatty tissue in the resected breasts. Twenty one breasts were studied following mastectomy for pure in situ carcinomas. The total volume and weight of the specimens were recorded and completed by specific densities of glandular and fatty tissue for each breast. This group was submitted to a calculation of proportions of glands and fat. The percentage of fat volume in the total breast volume varied from 7 to 56% and the percentage of fat weight in the total breast weight varied from 3.6 to 37.6%. This great variability in the respective proportions of fat and glands in the evaluated specimens was not significantly correlated to age and body mass index.
